Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability


Helping Payers Implement Value-Based Hospital Reimbursement

June 11, 2018 - Hospitals generate some of the largest revenues and create exceptionally high costs for payers, which combine open the possibility for value-based hospital reimbursement programs to control spending.        In March 2018, hospital prices grew by 3.3 percent and were some of the most significant drivers of increases in total healthcare costs, according to the Health Care...

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Using Social Determinants of Health for Risk Stratification

by Thomas Beaton

Engaging in meaningful risk stratification of beneficiaries requires accurate data that can highlight opportunities to reduce costs and improve outcomes for plan members. In order for payers to develop accurate and detailed risk stratification...

How Payers Can Effectively Scale Value-Based Care Networks

by Thomas Beaton

Value-based care networks are a promising opportunity for payers that want to manage costs and improve outcomes of beneficiaries.  But effectively scaling collaborative, risk-based reimbursement networks for millions of beneficiaries requires...

How Payers Address Deep-Rooted Social Determinants of Health

by Thomas Beaton

The social determinants of health (SDOH) have gained traction in payer discussions and are driving payers to take a thoughtful look into factors that create long-lasting effects on healthcare costs and outcomes. Payers recently have implemented...

Bundled Payments Require Clinical Insights, Provider Buy-In

by Thomas Beaton

Payers see bundled payments as a way to promote value-based reimbursement practices but must first leverage clinical insights and provider buy-in to maximize a bundle’s potential effectiveness. Bundled payments are valuable to payers because...

How Payers Can Succeed in Association Health Plan Markets

by Thomas Beaton

Association health plans (AHPs) may completely alter the nation’s health insurance markets with increasing support from federal entities and a handful of state insurance commissions. An expansion of the AHP market may materialize based...

Member Engagement is Key for High-Deductible Health Plan Success

by Thomas Beaton

Payers and employers who offer high-deductible health plans (HDHPs) to attract low-cost members may need member engagement strategies to generate higher value for these beneficiaries. Member engagement is critical for HDHP success because low...

Patient, Provider Engagement Drives High Health Plan Performance

by Thomas Beaton

Health plan performance, and how to improve it, is always an issue at the forefront of payers’ minds.  While payers have engaged in several strategies in the past aimed at improving clinical quality, reducing costs, and boosting outcomes,...

Member Incentives for Lower Cost Health Services Saved Payer $3.2M

by Thomas Beaton

Commercial payers struggling to curb costs and encourage their members to make smarter financial choices may be able to save millions of dollars each year by investing in modest member incentives. Offering small financial rewards for choosing...

Payer, Provider Collaboration Required for Accountable Care Success

by Thomas Beaton

The accountable care organization (ACO) movement has gained traction over the last year as payers and providers begin to share the same viewpoints on the benefits of value-based care. Provider attitudes about ACOs and related value-based care...

Employer Health Plans Can Engage Members with Data, Targeting

by Thomas Beaton

The use of data analytics and employee wellness engagement platforms may help employer health plans improve spending efficiency while producing a healthier, more productive workforce.    Employees are not always ready to take part in...

Quality Measures Challenging in Pharmaceutical Value-Based Contracts

by Thomas Beaton

Healthcare payers may find it difficult to establish value-based contracts (VBCs) with pharmaceutical companies due to the challenges of creating meaningful, workable quality measures.   Pharmaceutical companies are generally reluctant to...

Payers Driving Value by Promoting Connected Care Models

by Thomas Beaton

As payers vie to remain competitive in commercial insurance markets, they must be able to effectively manage consumer costs while providing beneficiaries the best possible healthcare experience now and in the future. Rising healthcare costs are...

Planning for Individual Insurance Exchange Stabilization in WA

by Thomas Beaton

State health insurance markets and their individual insurance exchanges have faced regular instability in the form of payer exits, imbalanced risk pools, and rising premiums that push out new and returning insurance consumers. As premiums go...

Medicaid Analytics Support Social Determinant Incentive Payments

by Thomas Beaton

Payers looking for innovative ways to control the costs of care have been turning their attention to the social determinants of health, the non-clinical factors that often lead to issues with care access, non-adherence, and the development of...

CMS Bundled Payment Models Lead to Greater Patient Selectivity

by Vera Gruessner

What are some of the biggest problems around bundled payment models and value-based care causing difficulties for physicians? According to Corporate Director at Willis-Knighton Health Systems Chris Mangin, the Comprehensive Care for Joint Replacement...

How Payers Could Assist Primary Care Docs with Value-Based Care

by Vera Gruessner

How can health insurance companies improve their relationship with primary care practices? How can payers work with primary care providers to expand value-based care reimbursement?  For answers to these questions,

Highmark Partners with Aledade’s Accountable Care Organizations

by Vera Gruessner

In December 2016, Aledade Inc., a leader of accountable care organizations (ACOs), and Highmark Blue Cross Blue Shield announced in a company press release a new partnership to provide quality medical treatment through accountable care organizations....

UnitedHealthcare Partners with Accountable Care Organizations

by Vera Gruessner

In December, UnitedHealthcare announced in a company press release the release of NexusACO, a new health plan option for self-funded employers that is available in 15 markets. Tier 1 of NexusACO involves offering healthcare access to members...

Why Healthcare Bundled Payment Models May Expand in 2017

by Vera Gruessner

The Centers for Medicare & Medicaid Services (CMS) have advanced bundled payment models by implementing these value-based payment structures in orthopedic and cardiac care. CMS released a finalized bundled payment model for cardiac and orthopedic...


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